Foreign Body Reaction to Acellular Dermal Matrix Allograft in Biologic Glenoid Resurfacing

Abstract

Background Biologic glenoid resurfacing is a treatment option for young patients with glenohumeral arthritis. An optimal synthetic graft for glenoid resurfacing should allow repopulation with host cells, be durable enough to tolerate suture fixation and forces across the joint, and present no host inflammatory response. We report two cases of giant cell reaction to GraftJacket 1 after biologic glenoid resurfacing. Case Description Two patients who underwent hemiarthroplasty and biologic glenoid resurfacing using GraftJacket 1 had a foreign body giant cell reaction that required revision surgery. Intraoperatively, both patients were observed to have a well-fixed humeral component and a dense, erythematous, synovitic membrane overlying the glenoid. Pathology specimens showed a benign reactive synovium, chronic inflammation, and foreign body giant cell reaction. After débridement and conversion to total shoulder arthroplasty, both patients continued to be painfree at greater than 1-year followup. Literature Review Multinucleated giant cell and mononuclear cell responses have been observed in an animal model after use of GraftJacket 1 . Although the use of acellular matrix-based scaffold for biologic glenoid resurfacing is not new, the possibility of foreign body reaction as a source of persistent symptoms has not been described. Clinical Relevance Given the lack of data to indicate an advantage to biologic resurfacing of the glenoid over hemiarthroplasty alone, resurfacing should not introduce significant additional surgical complications. We suggest foreign body reaction be considered in the differential diagnosis for a persistently painful shoulder after biologic glenoid resurfacing using an acellular allograft patch.

The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure

“…Thus, they may continue to act as a potential inflammatory stimulant, which may require surgical removal. 24 Second, some implanted collagen materials contain a relatively high DNA content from the host source—human, bovine, or porcine 9 —which may also contribute to the high rate of rejection seen when these materials are implanted into the human joint. 34 In contrast, the BEAR implant is processed to reduce the bovine DNA content to less than 50 ng per milligram of scaffold.…”

Orthopedic Applications of Acellular Human Dermal Allograft for Shoulder and Elbow Surgery

“…25 There was a report of foreign body reactions when ADM was used in this procedure, one of the only reports in the literature regarding this type of reaction. 26 Currently it is unclear if biologic resurfacing of the glenoid remains a good option for the treatment of shoulder arthritis. The results in the literature have been variable.…”

Untitled

“…These results have not been reproduced in other series and they documented 44-77% failure rates [15,16,17,18]. Significant foreign body reaction with this procedure has been reported in one series [19].…”